Shoulder Tendonitis (Dr Ayesha Kharal)

 Shoulder tendinitis:    

                                         a common overuse injury in sports (such as swimming, baseball and tennis) where the arm is used in an overhead motion. The pain – usually felt at the tip of the shoulder and referred or radiated down the arm – occurs when the arm is lifted overhead or twisted. In extreme cases, pain will be present all of the time and it may even wake you from a deep sleep. . The Humerus (upper arm bone), the tendons of the rotator cuff that connect to the muscles that lift the arm, and associated bursa (friction reducing membranes), move back and forth through a very tight archway of bone and ligament called the coracoacromial arch. When the arm is raised, the archway becomes smaller and compresses the tendons and bursa. Repetitive use of the arm makes the tendons and bursa prone to injury and inflammation.                                                              

Tendinitis occurs when a rotator cuff tendon becomes inflamed, swollen and tender. Symptoms of tendinitis and bursitis usually last for only a few days, but may recur or become chronic.                          

  Stages of Tendinitis     

                                                       Overuse tendinitis. Shoulder motions used during activities like golfing, throwing or overhead lifting may cause repetitive stress within the rotator cuff, leading to irritation, bruising or fraying of the tendon. This can cause shoulder pain and weakness in the joint.

 • Calcific tendinitis. Inflammation over a long period of time can sometimes result in a build-up of calcium deposits within the rotator cuff tendons. This leads to pain and loss of shoulder strength and motion.

 • Impingement tendinitis. When the space is narrowed between the rotator cuff and the coracoacromial arch, the humerus can “pinch” the rotator cuff tendon into the arch. This can happen when the cuff is weak, the bursa is swollen or if there is a bone spur present. Tendinitis caused by impingement can occur with repetitive shoulder activities, such as sports or jobs involving overhead reaching.

 • Rotator cuff tear. Severe tendinitis from long term impingement, degeneration, or sudden injuries like falling can cause partial or complete tearing of the rotator cuff tendon(s). This can result in more severe shoulder pain, weakness and loss of normal movement and function.

Contributing Factors 

• Overuse. Repetitive overhead motions are the most common cause of the problem. 

• Weak muscles. When the muscles are weak, more force is exerted on the tendons and bursa, causing inflammation and pain.

 • Improper/ inappropriate swimming or throwing techniques. 

• Strenuous training. One hard throw, weight lift or workout may start the problem.

 • Previous injuries to the shoulder. 

• Loose shoulder joint

Treatment

Rest. Avoid things that hurt or make the pain worse the next day. Avoid the activity that started the problem. Your doctor may recommend a sling to immobilize the shoulder. •

 Ice. Apply an ice bag (over a towel) to your shoulder at least twice a day for 20 minutes. Also apply ice after any activity that aggravates your shoulder pain. • 

Medication. Your doctor may prescribe anti-inflammatory/analgesic medication (in tablet form) to relieve pain and inflammation while your body’s natural healing process goes on. An injection of cortisone with procaine  into the shoulder may be recommended. After receiving an injection, do not attempt any vigorous activities with your arm for at least two weeks.

 Physical therapy. Your doctor may send you to a physical therapist for exercises or other therapy. Exercises to strengthen the shoulder may help to prevent a recurrence.

 Surgery. Surgery may be required to treat shoulder tendinitis and bursitis if it becomes chronic or if there is a tear of the rotator cuff.   

                                                                    Dr Ayesha Rai

                     MS Orthopedics